Common Errors of Medical Claims and Proposed Remedies
It can be quite disheartening to have your medical claim rejected for various reasons when you are in need of it. Unfortunately, this problem is common in the recent times, and perhaps, it is high time that you know some of the mistakes made by people during medical claims and how you can avoid such mistakes to make a successful claim. You must not continue receiving high medical claim rejections, and it is time that you learned the mistakes that result in claim denial and how you can rectify them. This article gives you the possible areas of medical claim rejection and the best solutions to adopt.
Missing details – Most insurers are keen on checking details on the claim form submitted to them by the medical service provider, and if any omission is present, they will reject it. Suppose any bit of information is missing from the claim form, then there are high rejection chances. Some people feel that other details are not crucial and they leave them out. Do not rush to fill and submit the form but spare some time to go through the claim form to check whether there are any missing details.
Duplicate claim or service – In some cases, you find that your medical service provider submits a double claim for the same services provided on the same date. This scenario is known as double insurance, and it is a common occurrence if the medical service provider is not keen. The medical service provider should invest in qualified staff to prepare the claims to ensure that no duplicate.
Service already adjudicated – Sometimes, a claim can be made when that claim had already been settled in another payment. Through embracing the latest technology on claim processing, you can avoid the instances of service already adjudicated. If you to minimize such instances in your organization, you can install the latest medical billing software which assures accurate processing of claims.
Not covered by payer – Sometimes, medical facilities make claims for medical procedures that were not outlined in a patient’s benefit plan. If the provider makes a mistake of claiming the service that is not in a patient’s benefit plan, then the insurer will turn it down. It is recommendable to refer to a patient’s benefit plan when preparing a claim or before you offer the services.
Deadline for claim submission – Usually, the medical claims have deadlines for submission, and you must note them. Late submission of claim can lead to rejection. However, it is crucial that you submit the claims in time so that even if it is rejected, you have ample time to make corrections and file the claims again before the deadline is due.